N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-8.6 - Rates for new facilities during the transition period
(a) General hospital outpatient clinics which
commence operation after December 31, 2007 and prior to January 1, 2012, and
for which rates computed pursuant to Public Health Law section 2807(2) are not
available shall have the capital cost component of their rates based on a
budget as submitted by the facility and as approved by the department and shall
have the operating component of their rates computed in accordance with the
following:
(1) for the period December 1,
2008 through November 30, 2009, 75 percent of such rates shall reflect the
historical 2007 average payment per visit as calculated by the department , and
25 percent of such rates shall reflect APG rates as computed in accordance with
this Subpart;
(2) for the period
December 1, 2009 through December 31, 2010, 50 percent of such rates shall
reflect the historical 2007 average payment per visit as calculated by the
department , and 50 percent of such rates shall reflect APG rates as computed in
accordance with this Subpart;
(3)
for the period January 1, 2011 through December 31, 2011, 25 percent of such
rates shall reflect the historical 2007 average payment per visit as calculated
by the department , and 75 percent of such rates shall reflect APG rates as
computed in accordance with this Subpart;
(4) for periods on and after January 1, 2012,
100 percent of such rates shall reflect APG rates as computed in accordance
with this Subpart;
(5) for the
purposes of this subdivision, the historical 2007 regional average payment per
visit shall mean the result of dividing the total facility specific Medicaid
reimbursement paid for general hospital outpatient clinic claims paid in the
2007 calendar year in the applicable upstate or downstate region for all rate
codes reflected in the APG rate-setting methodology except those specifically
excluded pursuant to section
86-8.10 of this Subpart, divided
by the total visits on claims paid under such rate codes.
(b) Diagnostic and treatment centers which
commence operation after December 31, 2007 and prior to January 1, 2012, and
for which rates computed pursuant to Public Health Law section 2807(2) are not
available shall have the capital cost component of their rates based on a
budget as submitted by the facility and as approved by the department and shall
have the operating cost component of their rates computed in accordance with
the following:
(1) for the period September
1, 2009 through November 30, 2009, 75 percent of such rates shall reflect the
historical 2007 regional average peer group payment per visit as calculated by
the department , and 25 percent of such rates shall reflect APG rates as
computed in accordance with this Subpart;
(2) for the period December 1, 2009 through
December 31, 2010, 50 percent of such rates shall reflect the historical 2007
regional average peer group payment per visit as calculated by the department ,
and 50 percent of such rates shall reflect APG rates as computed in accordance
with this Subpart;
(3) for the
period January 1, 2011 through December 31, 2011, 25 percent of such rates
shall reflect the historical 2007 regional average peer group payment per visit
as calculated by the department , and 75 percent of such rates shall reflect APG
rates as computed in accordance with this Subpart;
(4) for periods on and after January 1, 2012,
100% of such rates shall reflect APG rates as computed in accordance with this
Subpart;
(5) for the purposes of
this subdivision, the historical 2007 regional average peer group payment per
visit shall mean the result of dividing the total facility specific Medicaid
reimbursement paid for diagnostic and treatment center claims for each peer
group , as defined in section
86-4.13 of this Part, paid in the
2007 calendar year in the applicable upstate or downstate region for all rate
codes reflected in the APG rate-setting methodology except those specifically
excluded pursuant to section
86-8.10 of this Subpart, divided
by the total visits on claims paid under such rate codes.
(c) Free-standing ambulatory surgery centers
which commence operation after December 31, 2007 and prior to January 1, 2012,
and for which rates computed pursuant to Public Health Law section 2807(2) are
not available shall have the capital cost component of their rates computed in
accordance with section
86-8.4(c) of this
Subpart and shall have the operating cost component of their rates computed in
accordance with the following:
(1) for the
period September 1, 2009 through November 30, 2009, 75 percent of such rates
shall reflect the historical 2007 regional average payment per visit as
calculated by the department , and 25 percent of such rates shall reflect APG
rates as computed in accordance with this Subpart;
(2) for the period December 1, 2009 through
December 31, 2010, 50 percent of such rates shall reflect the historical 2007
regional average payment per visit as calculated by the department , and 50
percent of such rates shall reflect APG rates as computed in accordance with
this Subpart;
(3) for the period
January 1, 2011 through December 31, 2011, 25 percent of such rates shall
reflect the historical 2007 regional average payment per visit as calculated by
the department , and 75 percent of such rates shall reflect APG rates as
computed in accordance with this Subpart;
(4) for periods on and after January 1, 2012,
100 percent of such rates shall reflect APG rates as computed in accordance
with this Subpart;
(5) for the
purposes of this subdivision, the historical 2007 regional average payment per
visit shall mean the result of dividing the total facility specific Medicaid
reimbursement paid for free-standing ambulatory surgery centers claims paid in
the 2007 calendar year in the applicable upstate or downstate region for all
rate codes reflected in the APG rate-setting methodology except those
specifically excluded pursuant to section
86-8.10 of this Subpart, divided
by the total visits on claims paid under such rate codes.
Notes
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